Provider Demographics
NPI:1881922912
Name:CHUNG, KRISTY NAROM (NP)
Entity type:Individual
Prefix:MRS
First Name:KRISTY
Middle Name:NAROM
Last Name:CHUNG
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:12291 WASHINGTON BLVD
Mailing Address - Street 2:SUITE 500
Mailing Address - City:WHITTIER
Mailing Address - State:CA
Mailing Address - Zip Code:90606-2500
Mailing Address - Country:US
Mailing Address - Phone:562-698-2541
Mailing Address - Fax:562-789-4339
Practice Address - Street 1:12291 WASHINGTON BLVD
Practice Address - Street 2:SUITE 500
Practice Address - City:WHITTIER
Practice Address - State:CA
Practice Address - Zip Code:90606-2500
Practice Address - Country:US
Practice Address - Phone:562-698-2541
Practice Address - Fax:562-789-4339
Is Sole Proprietor?:No
Enumeration Date:2009-12-01
Last Update Date:2013-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA19274363LA2200X, 363LX0106X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No363LX0106XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerOccupational Health